A case of fulminant neurogenic pulmonary edema successfully treated with phenoxybenzamine and sildenafil

Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema following a central nervous system injury.Although the mortality rate for fulminant NPE ranges from 60% to 100%, there are few reports on specific treatment modalities.We present a case of life-threatening and prolonged NPE after brain tumor surgery, successfully treated with phenoxybenzamine and sildenafil.Seven hours post-surgery for a tumor in the posterior medulla, a 5-year-old girl developed pinkish foamy secretions in her endotracheal tube and experienced progressive respiratory failure.A mechanical ventilator failed to maintain adequate oxygenation and ventilation.Extracorporeal membrane oxygenation was subsequently initiated.She exhibited rapidly fluctuating systolic blood pressures, ranging from 57 to 156 mm Hg within minutes.Attempts to reduce positive end-expiratory pressure to below 10 cm H 2 O repeatedly failed due to recurrent pulmonary edema and bloody secretions.Phenoxybenzamine was administered on postoperative day (POD) 15, followed by sildenafil on POD 28.These oral medications enabled her to be discharged home without any respiratory support.Phenoxybenzamine and sildenafil may offer a potential treatment option for patients with fulminant and prolonged NPE when no other treatments are available.